{literal}
<script language="javascript">
function add_x12()
{
if (document.x12_partner.name.value.length>0)
{
top.restoreSession();
document.x12_partner.submit();
}
else
{
document.x12_partner.name.style.backgroundColor="red";
document.x12_partner.name.focus();
}
}

 function Waittoredirect(delaymsec) {
 var st = new Date();
 var et = null;
 do {
 et = new Date();
 } while ((et - st) < delaymsec);

   }
</script>
{/literal}

<form name="x12_partner" method="post" action="{$FORM_ACTION}">
<table width="400px" style="font-size:9pt;" CELLSPACING="0" CELLPADDING="3" border="0">
    <tr>
        <td colspan="2">{xl t='X12 Partner'}</td>
    </tr>
    <tr>
        <td ALIGN="LEFT" VALIGN="MIDDLE" >{xl t='Partner'}&nbsp;{xl t='Name'}</td>
        <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" ><input type="text" size="20" name="name" value="{$partner->get_name()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td ALIGN="LEFT" VALIGN="MIDDLE" >{xl t='ID'}&nbsp;{xl t='Number'}&nbsp;({xl t='ETIN'})</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="id_number" value="{$partner->get_id_number()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='User logon Required Indicator (ISA01~ use 00 or 03)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="2" name="x12_isa01" value="{$partner->get_x12_isa01()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='User Logon (If 03 above, else leave spaces) (ISA02)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_isa02" value="{$partner->get_x12_isa02()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='User password required Indicator (ISA03~ use 00 or 01)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="2" name="x12_isa03" value="{$partner->get_x12_isa03()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='User Password (ISA04~ if 01 above, else leave spaces)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_isa04" value="{$partner->get_x12_isa04()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
        <td VALIGN="MIDDLE" >{xl t='Sender ID Qualifier (ISA05)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa05" options=$partner->get_idqual_array() selected=$partner->get_x12_isa05()}</td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Sender ID (ISA06)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_sender_id" value="{$partner->get_x12_sender_id()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Receiver ID Qualifier (ISA07)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa07" options=$partner->get_idqual_array() selected=$partner->get_x12_isa07()}</td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Receiver ID (ISA08)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_receiver_id" value="{$partner->get_x12_receiver_id()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Acknowledgment Requested (ISA14)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa14" options=$partner->get_x12_isa14_array() selected=$partner->get_x12_isa14()}</td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Usage Indicator (ISA15)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_isa15" options=$partner->get_x12_isa15_array() selected=$partner->get_x12_isa15()}</td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Application Sender Code (GS02)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_gs02" value="{$partner->get_x12_gs02()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Submitter EDI Access Number (PER06)'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_per06" value="{$partner->get_x12_per06()}" onKeyDown="PreventIt(event)" /></td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Version'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="x12_version" options=$partner->get_x12_version_array() selected=$partner->get_x12_version()}</td>
    </tr>
    <tr>
        <td VALIGN="MIDDLE" >{xl t='Processing'}&nbsp;{xl t='Format'}</td>
        <td COLSPAN="2" VALIGN="MIDDLE" >{html_options name="processing_format" options=$partner->get_processing_format_array() selected=$partner->get_processing_format()}</td>
    </tr>
    <tr>
	<td VALIGN="MIDDLE" >{xl t='Application Receiver Code (GS03 - If blank ISA08 will be used)'}</td>
	<td COLSPAN="2" VALIGN="MIDDLE" ><input type="text" size="20" name="x12_gs03" value="{$partner->get_x12_gs03()}" onKeyDown="PreventIt(event)" maxlength="15"/></td>
    </tr>
<tr height="25"><td colspan="2">&nbsp;</td></tr>
<tr>
	<td colspan="2">
		{if $partner->get_id() eq ""}
			<a class="css_button" href="javascript:add_x12();"><span>{xl t='Save'}</span></a>

		{else}
			<a class="css_button" href="javascript:add_x12();"><span>{xl t='Save'}</span></a>
		{/if}
	<a href="controller.php?practice_settings&x12_partner&action=list"  {php} if (!$GLOBALS['concurrent_layout']) echo "target='Main'"; {/php} class="css_button" onclick="top.restoreSession()">
<span>{xl t='Cancel'}</span></a></td>
</tr>
</table>
<input type="hidden" name="id" value="{$partner->id}" />
<input type="hidden" name="process" value="{$PROCESS}" />
<input type="hidden" name="sub" value="no" />
</form>
